Abstract P467: Premature Coronary Artery Disease Mortality in the Appalachian Region: Is the Problem Driven by Rural-urban or Socioeconomic Disparities?

Abstract

Background: Premature mortality under the age of 75 years exacerbates the burden of coronary artery disease (CAD) as the leading cause of death in the nation, with particular concerns being raised about its disproportionate effect on the vulnerable population of the Appalachian region compared to other regions of the United States. It is unknown whether the problem of premature CAD mortality in the Appalachian residents is further aggravated by disparities across various population groups within the Appalachian region itself. We hypothesized that within-region socioeconomic and geographic (rural-urban) disparities, independently of each other, aggravate the premature CAD mortality problem in the Appalachian population. Methods: A population-based study of age-adjusted premature CAD mortality among 25-74 year old residents of the Appalachian region was conducted (n=63,630,221). Counties’ rurality status was defined using the U.S. Department of Agriculture Economic Research Service’s (USDA ERS) Rural-Urban Continuum Codes: of 420 Appalachian counties, 217 were classifies as rural and 203 - as urban. To adjust for multiple covariates, general linear modeling (GLM) analysis was conducted (SAS, ver. 9.4). Results: Age-adjusted premature CAD mortality rates were higher in rural than urban Appalachian counties: 99.0 + 40.2 vs. 78.8 + 26.4 per 100,000 (p<0.01). Compared to urban counties, their rural counterparts had a higher prevalence of poverty (30.8 + 7.3% vs. 24.4 + 5.7%, p<0.01), unemployment (8.1 + 2.0% vs. 6.7 + 1.2%, p<0.01), lack of insurance (18.4 + 3.5% vs. 16.0 + 3.6%, p<0.01), smoking (22.2 + 3.8% vs. 20.2 + 2.9%, p<0.01), obesity (33.1 + 3.8% vs. 32.0 + 3.5%, p<0.01), sedentary lifestyle (32.2 + 4.5% vs. 29.6 + 4.7%, p<0.01). In the multivariate-adjusted analysis, smoking ( beta 3.322, p<0.01), sedentary lifestyle ( beta 0.947, p<0.01), healthcare services accessibility and utilization ( beta -0.532, p<0.05), unemployment ( beta 2.761, p<0.05) and poverty ( beta 0.652, p<0.05) were statistically significantly associated with age-adjusted premature CAD mortality. Conclusions: Premature CAD mortality in rural Appalachian counties is statistically significantly higher than in urban Appalachian counties. Socioeconomic disparities and modifiable CAD risk factors further aggravate the problem.